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Intraoperative Complications (intraoperative + complications)
Selected AbstractsNeedlescopic versus laparoscopic cholecystectomy: a meta-analysisANZ JOURNAL OF SURGERY, Issue 6 2009Muhammad S. Sajid Abstract Background:, To systematically analyse clinical trials on needlescopic (NC) versus laparoscopic cholecystectomy (LC) that evaluated the effectiveness of both procedures for the management of cholelithiasis. Methods:, A systematic review of the literature was undertaken. Clinical trials on NC versus LC were selected according to specific criteria and analyzed to generate summative data expressed in standardized mean difference. Results:, Sixteen trials on NC versus LC encompassing 1549 patients were retrieved from electronic databases. Only six randomized controlled trials on 317 patients qualified for the meta-analysis according to inclusion criteria. NC was associated with longer operative time and higher conversion rate as compared with LC. There was statistically significant heterogeneity among trials. Intraoperative complications, postoperative complications and total stay in hospital were not significantly different. NC was superior to LC in terms of less post-operative pain and better cosmetic outcomes. Conclusion:, NC is a safe and effective procedure for the management of gallstone disease. NC is as effective as LC for perioperative complications and total stay in hospital. NC is superior to LC for less post-operative pain and better cosmetic results. NC is associated with longer operative time and higher conversion rate. [source] Laparoscopic management of urachal remnants in adulthoodINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2006TAKATSUGU OKEGAWA Background: The aim of this study was to investigate the outcome of laparoscopic excision of urachal remnants (LUR), and to compare the outcome with that of the traditional open excision of urachal remnants (OUR). Methods: Between February 2001 and December 2005, six patients with a mean age of 23.8 years who had a symptomatic urachal sinus underwent radical LUR. Using 12 mm and 5 mm ports, the caudal stump of the urachus was ligated with an absorbable clip and divided. The peritoneal and preperitoneal tissue between the medial umbilical ligaments was dissected free of the transversalis fascia. Dissection was carried out along the preperitoneal plane toward the umbilicus. The cephalic side of the lesion was ligated at the umbilicus with an endo-loop and divided. In addition, four patients who underwent a traditional OUR were included. Peri- and postoperative records were reviewed to assess morbidity, recovery, and outcome. Results: The operative duration was not significantly shorter for the LUR group than the OUR group, but there was generally a reduction in blood loss (mean 16.5 vs 68.3 mL), an earlier resumption of eating (mean 1.3 vs 2.5 days), and a shorter hospital stay (mean 5.3 vs 10.5 days). There were no intraoperative complications in either the LUR or the OUR group. Mean follow up was 5 (range 4,12) months. There were no postoperative complications. Conclusions: The results suggest that LUR can be safely and satisfactorily performed in adulthood. [source] Complications and myoma recurrence after laparoscopic uterine artery occlusion for symptomatic myomasJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2006Zdenek Holub Abstract Aim:, To determine the frequency and severity of complications and the recurrence of fibroids as a result of laparoscopic occlusion of the uterine artery (LOUA) in women with symptomatic fibroids. Methods:, One hundred and fourteen women with symptomatic fibroids were treated using ultrasonically activated shears, clips or electrosurgery. A retrospective evaluation of the complications and recurrence rate was carried out. For each patient, the analysis took place at least 3 months after the procedure was performed. Each complication was categorized using the complication classifications developed by the Czech Society of Gynecologic Endoscopy and a modified set of the classifications of the American College of Obstetricians and Gynecologists. All adverse events that occurred during the follow-up period were included, in addition to those that occurred after the 3 months minimum interval. Results:, A total of eight women (7.1%, 95% confidence intervals [CI], 3.3,14.4) experienced complications; one of these women had two complications, resulting in a total of nine adverse events. There were no intraoperative complications and no permanent injuries. Two women required supracervical hysterectomy and myomectomy, respectively, as a result of fibroid necrosis. One patient had an undiagnosed endometrial stromal sarcoma after 12 months of LOUA. The rate of fibroid recurrence was 9.0% (10 patients). The recurrence-free survival interval rate (no clinical failure, no recurrence) at 23.6 months (median) follow-up was 88.3% (CI 84.9,93.5). Conclusion:, The rate of complications and fibroid recurrence was low in patients undergoing LOUA. [source] Long-term results of subtotal colectomy for acquired hypertrophic megacolon in eight dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2008T. Nemeth Objectives: To evaluate the long-term results of subtotal colectomy for acquired hypertrophic megacolon in the dog. Methods: Eight dogs with acquired hypertrophic megacolon underwent subtotal colectomy with preservation of the ileocolic junction. Long-term follow-up was obtained by clinical records and telephone interviews with the owners. Results: Eight large-breed dogs (age range: 6 to 12 years; mean age: 10·75 years) were enrolled. The use of bone meal, low levels of exercise, chronic constipation with dyschesia and tenesmus refractory to medical management were factors predisposing dogs to acquired hypertrophic megacolon. The diagnosis was confirmed in all animals by abdominal palpation, plain radiography and postoperative histopathological findings. There were no intraoperative complications. One dog died as a result of septic peritonitis. The clinical conditions (that is, resolution of obstipation and stool consistency) of the remaining seven dogs were improved at discharge; all animals returned to normal defecation in five to 10 weeks (mean: 7·3 weeks) and were alive 11 to 48 months (mean: 40·5 months) after surgery. Clinical Significance: Predominantly bony diet and/or low levels of physical activity may predispose dogs to acquired hypertrophic megacolon. Our results emphasise the long-term effectiveness of subtotal colectomy with preservation of the ileocolic junction in this condition. [source] Radiosurgery versus carbon dioxide laser for dermatochalasis correction in Asians,LASERS IN SURGERY AND MEDICINE, Issue 2 2007Carol S. Yu MBBS (Hons), MRCS (Edin) Abstract Background and Objectives Carbon dioxide (CO2) laser and radiosurgery are techniques commonly employed in oculoplastic surgery. However, there is no literature comparing their results in blepharoplasty. Study Design/Materials and Methods Twenty Chinese patients with dermatochalasis underwent radiosurgery in one upper eyelid and CO2 laser in the contralateral eyelid. Intraoperative time, hemorrhage, and pain control were assessed. Subjects were evaluated at postoperative 1 hour, 1 week, 1 month, and 3 months for hemorrhage and wound healing by a masked assessor. Results All patients reported minimal pain with either technique. A significantly shorter operative time was achieved with CO2 laser, with better intraoperative hemostasis. There was no significant difference in postoperative hemorrhage and wound swelling between radiosurgery and CO2 laser. No significant intraoperative complications were noted. Conclusions Both radiosurgery and CO2 laser are equally safe and effective for upper lid blepharoplasty. CO2 laser achieves shorter operative time with superior intraoperative hemostasis. Lasers Surg. Med. 39:176,179, 2007. © 2007 Wiley-Liss, Inc. [source] Repair of vaginal vault prolapse and pelvic floor relaxation using polypropylene mesh,NEUROUROLOGY AND URODYNAMICS, Issue 7 2005Matthew P. Rutman Abstract Aims The sacrouterine ligament/cardinal (SULC) complex and prerectal fascia attach at the perineal body, forming a single support unit preventing levator descent. Many patients with vault prolapse have levator descent and widening of the hiatus. Existing transvaginal procedures do not address pelvic floor descent. We describe a technique utilizing polypropylene mesh to repair pelvic floor relaxation and prevent levator descent, along with restoration of the SULC complex in vaginal vault repair. Materials and Methods We prospectively evaluated 50 patients who had a transvaginal mesh vault/posterior wall reconstruction. A T-shaped soft prolene mesh is prepared fixing the two arms of the mesh and recreating the SULC complex in support of the cuff. The vertical segment of the mesh is transferred over the prerectal fascia and secured to the pelvic floor musculature. The rectocele is repaired incorporating the mesh distally preventing pelvic floor descent. Surgical outcome was determined by patient self-assessment including quality of life (QoL) measure as well as pelvic examination using POP-Q staging. Results Mean age was 67 years. Mean follow-up was 6 months (range 3,12). There were no intraoperative complications. There have been two apical (4%) recurrences. Mean QoL score postoperatively on a 0,6 scale was 0.74 (0,=,delighted, 1,=,pleased). Pelvic floor descent has been repaired on all patients. Postoperative POP-Q reveals restoration of normal anatomy. Conclusions We report a new technique that recreates the SULC complex in support of the vaginal vault with the aid of prolene mesh. It is the first transvaginal procedure described to reconstruct the pelvic floor in attempt to prevent pelvic floor descent. Neurourol. Urdynam. © 2005 Wiley-Liss, Inc. [source] Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment optionsPRENATAL DIAGNOSIS, Issue 3 2009Waldo Sepulveda Abstract Objective To report three cases of large placental chorioangiomas managed with endoscopic laser coagulation of the feeding vessels, and review the literature regarding cases of chorioangioma treated with invasive techniques. Methods Intrauterine endoscopic surgery was performed using a 2.5-mm fetoscope under epidural anesthesia. Coagulation of the feeding vessels was attempted with laser energy, and the operation was completed with amniodrainage. Results The feeding vessels were successfully coagulated in one case, resulting in a term delivery. Histopathologic examination of the placenta confirmed a capillary chorioangioma with extensive necrosis. There were intraoperative complications in the other two cases, including bleeding at the site of coagulation requiring intrauterine transfusion in one, and incomplete vascular ablation in the other. In the former case the infant was born prematurely and developed chronic renal insufficiency. In the latter, the fetus died within the first week of the surgery. Conclusions There are limited interventions available for the management of large, symptomatic placental chorioangiomas. Although they can be treated with endoscopic laser coagulation of the feeding vessels, fetal bleeding, exsanguination, and death are potential complications of the procedure; therefore, this technique should be used with caution. The role of this treatment modality in the early devascularization of placental chorioangiomas prior to the development of significant complications warrants consideration. Copyright © 2009 John Wiley & Sons, Ltd. [source] New Enhancements of the Scrotal One-Incision Technique for Placement of Artificial Urinary Sphincter Allow Proximal Cuff PlacementTHE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010Steven K. Wilson MD ABSTRACT Introduction., Urinary incontinence impairs sexual functioning and sexual satisfaction. Traditional artificial urinary sphincter (AUS) implantation requires perineal incision for cuff placement and a second inguinal incision for reservoir and pump placement. We believed AUS could be placed easier and quicker through one scrotal incision. Aim., In an effort to effect more proximal placement of the cuff while keeping the advantages of the one scrotal incision technique, we report enhancements to the original surgical technique. Methods., Thirty patients have been operated upon using the enhanced technique. A modification of the SKW retractor system (AMS) facilitates deep bulbar exposure. Twenty patients were first time implantations and 10 were revisions with five of the revisions having had the original AUS placed by traditional two-incision technique. Two of the first time AUS patients received an inflatable penile prosthesis through the same incision. Main Outcome Measures., We evaluated site of cuff placement, sizes of cuffs used, postoperative continence status. Results., All of the virgin AUS required dissection of the bulbocavernosus muscle prior to cuff placement. In scrotally placed revisions, replacement cuffs were situated considerably proximal (4.5,7.5 cm) to the original cuff site. The perineal placed revisions were accomplished through a scrotal incision with replacement of two cuffs in the same site and the three other patients immediately distal. No intraoperative complications were seen. One patient developed scrotal hematoma requiring drainage. Only 15 patients are available for follow-up and all are socially continent (one pad or less). Conclusions., Transscrotal approach is used safely and efficiently for penile implants and AUS implantation. The new enhancements to the one-scrotal incision technique allow more proximal cuff placement as evidenced by the bulbocavernosus muscle dissection and use of larger cuffs. Continence rate is similar to rates achieved with perineal placement of cuff found in the literature. Wilson SK, Aliotta PJ, Salem EA, and Mulcahy JJ. New enhancements of the scrotal one incision technique for placement of artificial urinary sphincter allow proximal cuff placement. J Sex Med 2010;7:3510,3515. [source] Comparison of laparoscopic and open adrenalectomy for pheochromocytoma in a single centerASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2010T Okegawa Abstract Introduction: Laparoscopic adrenalectomy is recognized as a safe and feasible surgical procedure for removing adrenal masses, though some reports have questioned its use because of an increased risk of cardiovascular complications. This study aims to compare laparoscopic surgery and open surgery for pheochromocytoma. Methods: We analyzed 26 patients operated on for adrenal pheochromocytoma (laparoscopic surgery: 11 patients; open surgery: 15 patients) at Kyorin University Hospital from April 1995 to July 2009. Patient records were analyzed with regards to operative time, blood loss, complications, blood pressure during surgery, amount of analgesia required in patient-controlled analgesia, time to oral intake, length of hospital stay, and other factors. Results: Mean tumor size was greater in the open surgery patients. Blood loss was significantly less extensive in the laparoscopic surgery patients. Rates of intraoperative hypertension (defined as a sudden rise in systolic blood pressure of >200 mmHg) and hypotension (systolic blood pressure of <80 mmHg) immediately after clamping of the adrenal vein were significantly lower in the laparoscopic surgery patients. No significant differences were found between the two groups with respect to operative time, occurrence of complications, and analgesic requirements. Only one case (9.1%) required conversion from laparoscopic to open surgery because intraoperative complications, specifically uncontrollable hemorrhaging. Time to oral intake after surgery and hospital stay were significantly shorter in the laparoscopic surgery patients. During the follow-up period, there was no mortability or recurrence of endocrinopathy in the two groups. Conclusion: We consider the safety of laparoscopic adrenalectomy for pheochromocytoma to be similar to that of open surgery. [source] Minimally invasive straight laparoscopic total proctocolectomy for ulcerative colitisASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010H. Ozawa Abstract Introduction: We have performed straight laparoscopic total proctocolectomy for ulcerative colitis, in which all procedures, including transection of the rectum and anastomosis, were performed in the abdominal cavity. The primary objective of this study was to evaluate whether straight laparoscopic total proctocolectomy is technically feasible and safe. Methods: A retrospective database identified 22 consecutive patients who underwent straight laparoscopic total proctocolectomy for ulcerative colitis between March 1998 and September 2007. Patients were excluded if they required emergency surgery. First, to create a stoma site, a mini-laparotomy to insert a 15 mm trocar was performed. Seven other trocars, 5 mm in diameter, were then inserted. Mobilization and dissection of the colorectum and anastmosis were performed completely intracorporeally under laparoscopic guidance. Anastomosis of an ileal J-pouch to the anal canal was performed using the double-stapling technique. Results: Nineteen patients were underwent ileal pouch anal canal anastomosis; two underwent ileorectal anastomosis; and one underwent abdominoperineal resection. The median operation time was 355 min (range 255,605); the median blood loss was 50 g (range 0,800); and the median postoperative hospital stay was 24.5 d. Postoperative complications occurred in eight patients, including three (13.6%) with bowel obstruction, two (9.1%) with portal vein thrombosis, one (4.5%) with anastomotic leakage, and one (4.5%) with postoperative hemorrhage. The morbidity rate was 36.4%. There were no intraoperative complications or conversions to conventional surgery. Conclusion: In the context of this study, we have shown that straight laparoscopic total proctocolectomy is technically feasible and safe in patients with ulcerative colitis. [source] Single-port, single-operator-light endoscopic robot-assisted laparoscopic urology: pilot study in a pig modelBJU INTERNATIONAL, Issue 5 2010Sebastien Crouzet Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVES To present our initial operative experience in which single-port-light endoscopic robot-assisted reconstructive and extirpative urological surgery was performed by one surgeon, using a pig model. MATERIALS AND METHODS This pilot study was conducted in male farm pigs to determine the feasibility and safety of single-port, single-surgeon urological surgery. All pigs had a general anaesthetic and were placed in the flank position. A 2-cm umbilical incision was made, through which a single port was placed and pneumoperitoneum obtained. An operative laparoscope was introduced and securely held using a novel low-profile robot under foot and/or voice control. Using articulating instruments, each pig had bilateral reconstructive and extirpative renal surgery. Salient intraoperative and postmortem data were recorded. Results were analysed statistically to determine if outcomes improved with surgeon experience. RESULTS Five male farm pigs underwent bilateral partial nephrectomy and bilateral pyeloplasty before a completion bilateral radical nephrectomy. There were no intraoperative complications and there was no need for additional ports to be placed. The mean (range) operative duration for partial nephrectomy, pyeloplasty, and nephrectomy were 120,(100,150), 110,(95,130) and 20,(15,30),min, respectively. The mean (range) estimated blood loss for all procedures was 240,(200,280),mL. The preparation time decreased with increasing number of cases (P = 0.002). CONCLUSIONS The combination of a single-port, a robotic endoscope holder and articulated instruments operated by one surgeon is feasible. With a single-port access, the robot allows more room to the surgeon than an assistant. [source] Robot-assisted laparoscopic adrenalectomy: preliminary UK resultsBJU INTERNATIONAL, Issue 3 2004S. Undre Authors from London describe the early results from the UK in the use of robot-assisted laparoscopic adrenalectomy. In a small group of patients they found that patients could be treated early, with early discharge from hospital. The use of retrograde balloon dilatation of PUJ obstruction is revisited by authors from Plymouth, who review their 10 years of experience with this technique. They found that the procedure gave good symptomatic relief in 76% of their patients, but found no relationship between symptom relief and renographic improvement. In a few patients with a long-term follow-up there was symptomatic improvement and good maintenance of split renal function. OBJECTIVE To describe the results of our first two cases of laparoscopic adrenalectomy using the da VinciTM surgical system (Intuitive Surgical, Inc., Mountain View, CA, USA). PATIENTS AND METHODS Amongst 75 robot-assisted procedures performed at our institution, two patients underwent robot-assisted laparoscopic adrenalectomy. The set-up time, procedure time, hospital stay, complications and outcomes were recorded. RESULTS Both operations were completed successfully using the robot; the mean (range) set-up time was 31 (25,37) min and mean procedure time 118.5 (107,130) min. One patient had a postoperative pulmonary embolus and was discharged 5 days after surgery; the second patient was discharged after 3 days. There were no intraoperative complications; both patients were well at the 1-year follow-up CONCLUSIONS Robot-assisted laparoscopic adrenalectomy is technically feasible and can be conducted efficiently and safely with the da Vinci surgical system. [source] Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2003C. Wullstein Background: Although laparoscopy may be associated with fewer intra-abdominal adhesions and quicker recovery of bowel function, it remains unclear whether patients with acute small bowel obstruction (SBO) might benefit from laparoscopic techniques. Method: The results of patients with acute SBO treated laparoscopically (LAP; n = 52) and conventionally (CONV; n = 52) were compared in a retrospective matched-pair analysis. Conversions were included in the laparoscopic group. Results: Complete laparoscopic treatment was performed in 25 patients (48·1 per cent). Major intraoperative complications occurred in 15 patients in the LAP group and eight in the CONV group (P = 0·156). Intraoperative perforations were more frequent in patients who had undergone more than one previous laparotomy (P = 0·066). Postoperative complications occurred in ten patients (19·2 per cent) in the LAP group and in 21 patients (40·4 per cent) who had conventional surgery (P = 0·032). Bowel movements started 3·5 days after operation in the LAP group and 4·4 days after conventional operation (P = 0·001). The length of hospital stay was 11·3 and 18·1 days respectively (P < 0·001). Conclusion: Laparoscopic treatment of acute SBO was feasible in about half of these patients. Postoperative recovery was improved after laparoscopic procedures but the risk of intraoperative complications increased. A laparoscopic approach seems justified in a subset of patients. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Cryo-assisted anterior approach for surgery of retroocular orbital tumours avoids the need for lateral or transcranial orbitotomy in most casesACTA OPHTHALMOLOGICA, Issue 6 2010Nachum Rosen Acta Ophthalmol. 2010: 88: 675,680 Abstract. Purpose:, To describe and evaluate a cryo-assisted, minimally invasive, anterior approach for orbital tumour surgery. Methods:, Retrospective, non-comparative, consecutive, interventional case series of 103 patients who were operated on by the same surgeon for retroocular orbital tumours over the last 16 years. Results:, A cryo-assisted, minimally invasive, anterior approach was employed in 63 out of the 103 patients (61.2%). In 37 patients (35.9%), anterior orbitotomy without the use of cryoprobe was employed for biopsy or excision of small, anteriorly located lesions. Lateral orbitotomy was used in three patients (2.9%). In a subgroup of 61 patients with circumscribed lesions (mainly cavernous haemangiomas and schwannomas), cryoextraction was used in 51 (83.6%). None of the procedures required conversion to lateral orbitotomy and there were no intraoperative complications. Conclusion:, In contrast to other reports on the treatment of orbital lesions, in the current case series surgery of most solid tumours and many other cystic or infiltrative lesions was achieved here via an anterior, cryo-assisted approach, and thus with minimal trauma to the orbit. This approach warrants more favourable consideration because the combination of the anterior approach with the use of cryoprobe and surgical microscope can yield successful results, even in patients with large or deeply located tumours , obviating in most of them the need for lateral or transcranial orbitotomies with bone flaps. [source] Incidence, clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosinACTA OPHTHALMOLOGICA, Issue 3 2009Ugur Keklikci Abstract. Purpose:, To determine the risk ratios and incidence of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients using tamsulosin, and to assess management strategies for IFIS. Methods:, We performed a non-randomized, observational, prospective study, in which 594 eyes of 579 patients undergoing cataract surgery were enrolled. Surgeons were masked to the patients' drug history. Usage or non-usage of tamsulosin, duration of tamsulosin use, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded in the patients' theatre notes. Results:, Twelve of 15 (80%) IFIS patients were taking systemic tamsulosin. Twelve of 23 (52%) patients using tamsulosin showed features of IFIS. The odds ratios (ORs) and relative risk (RR) ratios show strong positive correlations between tamsulosin use and IFIS. The ORs and RR ratios and the 95% confidence intervals (CIs) are as follows: OR 206.5 (95% CI 50.9,836.5); RR 99.3 (95% CI 30.0,327.8). There were no statistically significant differences between patients with or without IFIS, who were using tamsulosin, in terms of age or duration of tamsulosin use (p > 0.05). Seven eyes (46.6%) with IFIS were successfully managed with epinephrine. Eight eyes (53.4%) with IFIS needed iris hooks. Conclusions:, Patients using tamsulosin appear to be at high risk of IFIS during cataract surgery. The occurrence of IFIS may not be affected by duration of tamsulosin use or age. Epinephrine may be effective in approximately 50% of eyes with IFIS. The iris hook procedure represents an effective management strategy in IFIS. [source] Boston KPro experience in BarcelonaACTA OPHTHALMOLOGICA, Issue 2008M DE LA PAZ Purpose To describe the indications, intraoperative complications, post-operative complications and anatomical and functional results of Type I Boston keratoprosthesis at our eye center in Barcelona. Methods Retrospective interventional case series on 24 eyes of 22 patients who underwent Boston keratoprosthesis implant from May 2006 to May 2008. Results The main indication for Boston keratoprosthesis implantation was a repeated failed graft (mean = 2.33 previous grafts). The most common principal pathologies were: bullous keratopathy, herpetic keratitis, aniridic keratopathy, corneal ectasia, calcific band keratopathy. No major intraoperative complications were noted and average time of surgery was 47 minutes. The mean follow-up time was 7.42 months. The major post-operative complications encountered were retroprosthetic membrane in 2 eyes, endophthalmitis in 2 eyes and corneal graft melting in 1 eye. The mean best corrected visual acuity improved from 0.015 pre-operatively to 0.1 post-operatively. Only one case of extrusion due to melting was encountered which was resolved by a reimplantation of the keratoprosthesis. Conclusion Our short-term experience with the type I Boston Keratoprosthesis is a good alternative for patients with repeated graft failures. Improvement in visual acuity is immediate and only minor complications were encountered. [source] Limbal anaesthesia versus topical anaesthesia for clear corneal phacoemulsificationACTA OPHTHALMOLOGICA, Issue 1 2006Carlo Cagini Abstract. Purpose:,To compare the safety and clinical efficacy provided by limbal anaesthesia with topical anaesthesia in cataract surgery. Methods:,A total of 117 consecutive patients undergoing routine cataract surgery were randomly assigned to receive limbal or topical anaesthesia. Limbal anaesthesia was administered with a cellulose ophthalmic sponge soaked in preservative-free lidocaine hydrochloride 4% applied to the temporal perilimbal area for 45 seconds immediately before surgery. For topical anaesthesia lidocaine 4% was instilled in each patient at 10-min intervals four times before surgery. We studied phaco time, perioperative pain, visual outcome and intraoperative complications. The level of intraoperative pain was scored on a scale of 1,10, where 1 = no pain and 10 = severe pain. Results:,55 patients (91.6%) in the topical group and 54 patients (94.7%) in the limbal group tolerated the procedure well, giving pain scores of 1,3, with no statistical difference. No patients in either group required supplemental anaesthesia and no intraoperative complications were recorded. No eyes had epithelial defects at the end of surgery or at postoperative check-ups. Conclusion:,Limbal anaesthesia in cataract surgery is safe and the two anaesthesia techniques do not present differences in the degree of analgesia achieved. [source] Topical versus peribulbar anaesthesia for cataract surgeryACTA OPHTHALMOLOGICA, Issue 6 2003Gangolf Sauder Abstract. Background:,To assess and compare the efficacy and safety of topical versus peribulbar anaesthesia in patients undergoing routine cataract surgery. Methods:,The unicentre, prospective, randomized, clinical interventional trial included 140 consecutive patients undergoing routine cataract surgery performed by one of two surgeons. The patients were randomly distributed to either peribulbar anaesthesia or topical anaesthesia. To assess intraoperative pain, each patient was asked immediately after surgery to quantitate his/her pain using a 10-point pain rating scale. Results:,The study groups did not differ significantly in pain score (p = 0.54), duration of surgery (p = 0.52), anaesthesia-related intraoperative difficulties (p = 0.17), postoperative visual acuity (p = 0.94), overall intraoperative surgical complication rate, blood pressure rise (p = 0.16) or blood oxygen saturation (p = 0.74) Conclusions:,Patient comfort and surgery-related complications did not differ between topical anaesthesia and peribulbar anaesthesia. As there are no significant differences between the two techniques in terms of subjective pain experienced by patients, intraoperative complications and postoperative visual outcome, and in view of the minimally invasive character of topical anaesthesia compared to peribulbar anaesthesia, the present study suggests the use of topical anaesthesia for routine cataract surgery. [source] Shape, height, and location of the lingula for sagittal ramus osteotomy in ThaisCLINICAL ANATOMY, Issue 7 2009P. Jansisyanont Abstract This study aims to investigate the shape, height, and location of the lingula in relation to surrounding structures for sagittal ramus osteotomy. Dried Thai mandibles were studied and compared with other races. From both sides of 92 mandibles, the shape of the lingula was classified into triangular, truncated, nodular, or assimilated types. Of 92 mandibles, 146 sides with at least a premolar and a molar on the same side were selected for distance measurement. Height of the lingula was measured from the lingular tip to the mandibular foramen. The location was determined by five distances from the lingular tip to: the anterior and the posterior borders of the mandibular ramus, the mandibular notch, the distal surface of the mandibular second molar, and the occlusal plane. The results showed that truncated lingulae were most frequently found (46.2%) and most appeared to be bilateral (71.7%). Triangular, nodular, and assimilated shapes presented in 29.9%, 19.6%, and 4.3%, respectively. The mean lingular height was 8.2 ± 2.3 mm. The lingula was located at 20.6 ± 3.5 mm from the anterior border of the mandibular ramus and 16.6 ± 2.9 mm from the mandibular notch. In the majority of the mandibles studied, the lingula was located above the occlusal plane. In conclusion, the shape and metric characteristics of the lingula in relation to surrounding structures in Thais vary from other races. All parameters associated with the lingula should be considered for sagittal ramus osteotomy to avoid intraoperative complications. Clin. Anat. 22:787,793, 2009. © 2009 Wiley-Liss, Inc. [source] Laparoscopic treatment of lymphoceles in patients after renal transplantationCLINICAL TRANSPLANTATION, Issue 6 2001Hans-Joachim Duepree Postoperative lymphoceles after renal transplantation appear in up to 18% of patients, followed by individual indisposition, pain or impaired graft function. Therapeutic options are percutaneous drainage, needle aspiration with sclerosing therapy, or internal surgical drainage by conventional or laparoscopic approach. The laparoscopic procedure offers short hospitalisation time and quick postoperative recovery. From 1993 to 1997, 16 patients underwent laparoscopic fenestration of a post-renal transplant lymphocele, and were presented in a retrospective analysis. Three patients have had previous abdominal surgery. Following preoperative ultrasound and CT scan, 16 patients underwent laparoscopic drainage after drainage and staining of the lymphocele with methylene blue. No conversion was necessary. Mean operation time was 42 min, no intraoperative complications were seen. Oral nutrition and immunosuppression were continued on the day of surgery, and patients were discharged between the 2nd and 5th (median hospital stay 3.3 d) day after surgery. No recurrence was evident in a follow-up time of 15,54 months (median 31.4 months). Renal function remained unchanged in all patients postoperatively. [source] | |||||||||||||||||||||||||